Handshake antimicrobial stewardship as a model to recognize and prevent diagnostic errors

Abstract

ObjectivesFew studies describe the impact of antimicrobial stewardship programs (ASPs) on recognizing and preventing diagnostic errors. Handshake stewardship (HS-ASP) is a novel ASP model that prospectively reviews hospital-wide antimicrobial usage with recommendations made in person to treatment teams. The purpose of this study was to determine if HS-ASP could identify and intervene on potential diagnostic errors for children hospitalized at a quaternary care children’s hospital.MethodsPreviously self-identified “Great Catch” (GC) interventions by the Children’s Hospital Colorado HS-ASP team from 10/2014 through 5/2018 were retrospectively reviewed. Each GC was categorized based on the types of recommendations from HS-ASP, including if any diagnostic recommendations were made to the treatment team. Each GC was independently scored using the “Safer Dx Instrument” to determine presence of diagnostic error based on a previously determined cut-off score of ≤1.50. Interrater reliability for the instrument was measured using a randomized subset of one third of GCs.ResultsDuring the study period, there were 162 GC interventions. Of these, 65 (40%) included diagnostic recommendations by HS-ASP and 19 (12%) had a Safer Dx Score of ≤1.50, (Κ=0.44; moderate agreement). Of those GCs associated with diagnostic errors, the HS-ASP team made a diagnostic recommendation to the primary treatment team 95% of the time.ConclusionsHandshake stewardship has the potential to identify and intervene on diagnostic errors for hospitalized children.

Optimizing rapid diagnostics and diagnostic stewardship in Gram‐negative bacteremia

“…Additionally, in pediatric patients with positive blood cultures, unsolicited intervention on RDT results was associated with improved antibiotic selection and high satisfaction rates (4.8/5) by providers 61 . Implementing a new culture on antimicrobial prescribing in the setting of RDTs that incorporates handshake stewardship can be done if the stewardship team forms rapport with providers and provides education while making recommendations 62–65 . This aligns with the findings that passive stewardship education (eg, presentations and conferences) is not as effective at altering prescribing patterns as active education (eg, patient‐specific education, education combined with audit and feedback) 66 …”

Antimicrobial stewardship program in pediatric medicine

“…An ASP must have an appointed and dedicated leader (either clinician or pharmacist) who will be responsible for successful program management, outcomes, and further development. The expectation from each member of the ASP is to participate in “diagnostic stewardship” that includes measures for improving diagnostic decisions for appropriate antimicrobial prescription 23 and “handshake stewardship” where there is personal interaction with prescribers to improve antimicrobial use 24 . Each member in the program should have clear responsibilities and expertise in their area, as designation of specific personnel for specific tasks promotes accountability.…”

“…Some are suitable to specific environments or circumstances and depend on the healthcare system and program resources: Prospective audit and feedback defined as an independent review of existent antimicrobial prescription 1–2 days after treatment initiation and analysis for appropriateness of prescribing (type of antimicrobials, dose, route of administration, and duration) 30 . Next, “ handshake stewardship ” as post‐audit personal feedback can be performed 24 . This provides educational opportunity and collaborative relationship between stewards and clinicians while maintaining autonomy and clinical judgment 31 .…”

“…The expectation from each member of the ASP is to participate in “diagnostic stewardship” that includes measures for improving diagnostic decisions for appropriate antimicrobial prescription 23 and “handshake stewardship” where there is personal interaction with prescribers to improve antimicrobial use. 24 Each member in the program should have clear responsibilities and expertise in their area, as designation of specific personnel for specific tasks promotes accountability. Furthermore, it is beneficial for ASP if ID‐trained physicians are included in the core team, or those without ID expertise to have training in ASP principles and practices, especially in small hospitals.…”

“… 30 Next, “ handshake stewardship ” as post‐audit personal feedback can be performed. 24 This provides educational opportunity and collaborative relationship between stewards and clinicians while maintaining autonomy and clinical judgment. 31 Real‐time, individualized, nonpunitive, and customized feedback can provide effective results in the improvement of the antimicrobial prescription pattern.…”